Provider Demographics
NPI:1659437333
Name:JENSEN, WENDY K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:K
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86684
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97286-0684
Mailing Address - Country:US
Mailing Address - Phone:503-624-1111
Mailing Address - Fax:503-774-3996
Practice Address - Street 1:9860 SW HALL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8896
Practice Address - Country:US
Practice Address - Phone:503-624-1111
Practice Address - Fax:503-774-3996
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical